T3 L3 Schizophrenia: clinical features Flashcards
What are neurosis disorders?
Anxiety disorders Depressive disorders Obsessive compulsive disorder Adjustment disorders Somatisation borders
What are psychosis disorders?
Organic
Schizophrenia
Bipolar disorder
Depressive psychosis
What is psychosis?
Illness characterised by loss of boundaries with reality & loss of insight with primary features of delusions & hallucinations
What is a psychotic episode?
1 week duration of either delusions and/or hallucinations at significant severity
What is a delusion?
Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary.
Not shared by someone of similar age, educational, cultural, religious or social background
What are some types of delusion?
Primary Secondary Persecutory Of reference Grandiose Of guilt Nihilistic Of passivity
Why do delusions occur?
Due to error of salience of attribution
Dopamine plays a role in motivation & reward. Excessive dopamine in these pathways could lead to the world seeming pregnant with significance
Give some examples of delusions
Religious, persecution by devil Persecution by authority figure / government Controlled by implant Responsibility for world tragedy Followed by seagulls
What is a hallucination?
Perception experienced in absence of external stimulus
In any sensory modality
Due to internal perception attribution error
What is the most common type of hallucination in psychosis?
Auditory
What did Esquirol do?
1838
Described course & prognosis of insanity & separated it from the diagnostic group of mood disturbances (melancholia) which had a better outcome.
What did Kraepelin do?
1898
Defined dementia praecox with onset in adolescence of progressive, irreversible decline in mental function
Different forms: hebephrenic, catatonic, paranoid & simplex
Distinguished from manic depressive illness
What did Bleuler do?
1911
Coined term schizophrenia with ‘splitting of the mind’ & described fundamental symptoms: abnormal associations, autism, abnormal affect, ambivalence
What did Schneider do?
1946
Defined first rank symptoms pathognomic of schizophrenia
What are the first rank symptoms?
In absence of organic disease signify schizophrenia
Auditory hallucinations
Somatic hallucinations
Thought insertion, withdrawal or broadcast
Passivity phenomena. Made acts / impulses / affect
Delusional perception
Found not to be inclusive of all subjects with schizophrenia
What is the ICD 10 diagnosis of schizophrenia?
Minimum of 1 a-d or 2 e-h for at least 1 month
A) Thought echo, insertion, withdrawal or broadcast
B) Delusion of passivity or delusional perception
C) Running commentary hallucination or 2 voices discussing the patient
D) Persistent delusions of other kinds
E) Persistent hallucinations in any modality with accompanying brief delusions
F) Breaks in thought resulting in abnormal speech (incoherent, neologisms)
G) Catatonic behaviour (excitement, posturing, wavy flexibility, negativism)
H) Negative symptoms not due to depression or medication
In absence of an organic disorder
What are some differential diagnosis?
Affective psychosis:
- Bipolar disorder
- Depressive psychosis
- Schizoaffective disorder
Organic psychosis:
- Epilepsy
- Infections
- Cerebral trauma
- Cerebrovascular disease
- Demyelination
- Neurodevelopmental disorders
- Endocrine
- Metabolic
- Immunological
- Acute drug intoxication
- Toxins
- Dementia
Personality disorder
What are some signs of schizophrenia?
Bizarre appearance or behaviour Self neglect Social disturbance Posturing Clothing Perplexity Talking to themselves
What side effects of medication are there that may present as schizophrenia?
Parkinsonian symptoms: tremor, rigidity, bradykinesia
Tardive dyskinesia including orofacial, athetosis, dystonias
Skin discolouration
Severe weight gain
Describe the mental state examination in an acute syndrome
Appearance: preoccupied & withdrawal to restless & unpredictable
Mood: blunting of mood, disinhibition, perplexed, anxious
Disorder of thinking: vague, formal thought disorder, disorders of stream
Delusions: primary, secondary
Hallucinations: auditory, visual, tactile, olfactory, gustatory
Insight: impaired
Cognition: normal orientation & memory
Describe the mental state examination in a chronic syndrome
Appearance: lack of drive & activity, social withdrawal, self neglect
Movement abnormalities: stupor, catatonia, abnormal movements & tone
Mood: blunting of mood, depression
Delusions: primary, secondary
Hallucinations: auditory, visual, tactile, olfactory, gustatory
Insight: impaired
Cognition: normal orientation but often cognitive decline
What is the prevalence of schizophrenia?
0.2-0.7%
What is the geography of schizophrenia?
Incidence up to 5X variation worldwide
Increased rate in migrants
More prevalent in urban than rural areas
Urban drift
Describe the age of onset of schizophrenia
Male peak onset at 21-26
Female peak onset at 25-32
What is the prognosis of schizophrenia?
Better outcome in 3rd world & with introduction of early intervention services
20% have complete recovery & off treatment
25% have persistent symptoms after first episode
>50% have relapsing remitting illness with some functional impairment between episodes
Recurrent episodes may lead to progressive deterioration
Suicide in 5-10%, particularly men within 3 years of onset
What increases the likelihood of a good prognosis of schizophrenia?
Female Married Family history of affective disorder Acute onset Life event at onset Early treatment Affective symptoms Good treatment response
What decreases the likelihood of a good prognosis of schizophrenia?
Male Single Family history of schizophrenia Premorbidly schizoid Slow onset Long duration untreated Negative symptoms Obsessions High expressed emotion in the family Substance misuse
What effect does cannabis have on psychosis?
Increases risk
Impact of cannabis on developing brain is more potent
Familial liability for psychosis is expressed as differential sensitivity to cannabis
Chronic use sensitises to effect & increases vulnerability to psychosis
